Leucocitosis con Neutrofilia, Las Neoplasias

Las neoplasias hematológicas y no hematológicas se pueden presentar con leucocitosis con neutrofilia. En tumores sólidos como el cáncer gástrico, de mama y de cuello uterino, la leucocitosis se puede presentar hasta en el 25,6% de los casos e incluso en el cáncer de cuello uterino es un factor pronóstico independiente (p = 0,007) (61). En Neoplasias mieloproliferativas como la Leucemia mieloide crónica (LMC), la leucocitosis es un hallazgo común, generalmente con un recuento de leucocitos mayor a 100.000 células/μL a expensas de formas inmaduras de neutrófilos. En las series reportadas para LMC infantil, los recuentos varían entre 250.000 y 750.000 células/μL (62-64).

El Tabaquismo

El fumar cigarrillo es tal vez la causa más frecuente de leucocitosis con neutrofilia en adultos. La neutrofilia leve se observa en 11,5% de los fumadores, en comparación con el 1,5% de los no fumadores (65). El número de cigarrillos consumidos al día y la duración del consumo, especialmente un consumo mayor a 5 años, se presenta como un mayor recuento de leucocitos (p <0,05) (66). El conteo aumentado de leucocitos puede persistir incluso de 2 a 5 años después del cese del consumo (67,68).

La Obesidad

La obesidad se asocia a neutrofilia crónica (69), se considera como un estado inflamatorio de bajo grado donde los adipocitos producen y liberan citoquinas proinflamatorias como IL-1, IL-6, TNF-alfa, las cuales generan un estado inflamatorio que es causa de neutrofilia (70).

Conclusiones

La leucocitosis con neutrofilia se asocia con causas infecciosas y no infecciosas, así como con enfermedades benignas o malignas que la convierten en un real desafío diagnóstico para el clínico. Éste debe elaborar en primera instancia, una adecuada historia clínica y un prolijo examen físico a fin de determinar un correcto estudio de la misma y así establecer su causa para, de esta manera, establecer un adecuado tratamiento. Sin embargo, en muchas ocasiones su causa no se puede identificar. De modo que en esta situación, el manejo debe ser multidisciplinario y referenciando a un centro de mayor complejidad, lo que resultará en un mejor pronóstico para el paciente.

Conflicto de interés

Los autores declaran no tener ningún conflicto de interés.

Financiación

Ninguna declarada por los autores.

Agradecimientos

Los autores expresan su agradecimiento a la Universidad del Cauca, en especial al departamento de Medicina Interna.

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Recibido: 18 de diciembre de 2017
Aceptado: 14 de agosto de 2018
Correspondencia:
Fabricio Andrés Lasso Andrade fabriciolasso@gmail.com